The consortium between the Massachusetts General Hospital and the Indira Gandhi Government Medical College Nagpur, India, affiliated with Lata Medical Research Foundation, has extensive experience in conducting international multicenter collaborative clinical trials/implementation science research dedicated to improving maternal and child health. Since 2008, the consortium has participated as a Research Unit (RU) in the Global Network (GN) for Women's and Children's Health Research and is applying to continue the productive and successful RU in Nagpur, India. The RU's goal is to continue to develop and implement GN sponsored common protocols that generate evidence and scientific knowledge to sustainably improve outcomes for women and children. The research that the MGH-Nagpur consortium proposes to develop is based on their current GN studies on the adverse effects of Household Air Pollution (HAP) on pregnancy and infant outcomes. Their GN research is focused in this area because 3 billion people (~ half of the world's population) and -80% of pregnant women in the GN still use traditional cook stoves and solid fuels that generate high levels of household pollutants, far exceeding World Health Organization (WHO) indoor air quality guidelines. WHO estimates that HAP causes 2 million deaths annually (mostly in women and children). They propose to develop a multicenter randomized clinical trial to evaluate whether pregnancy and infant outcomes can be improved by introduction of cook stoves/fuel that reduce HAP in households where pregnant women, in their first trimester, are using traditional cook stoves. The primary outcome is birth weight. Secondary outcomes are preterm birth, perinatal/neonatal mortality, childhood pneumonia/neonatal sepsis and adverse child growth/development. They also propose to measure HAP levels in women and children in a random subset of households to improve knowledge about the biological basis of the effects of HAP - including particulate matter < 2.5 micrometers, carbon monoxide and biomarkers 1-hydroxypyrene, methoxyphenol and cotinine (tobacco smoke). Successful introduction of cook stoves/fuel that reduce HAP has the potential to sustainably improve pregnancy outcomes and child health in resource limited settings. Public Health Relevance: More than 3 billion people use traditional stoves and biomass fuels for cooking. Pregnant women and young children bear most of the burden of health consequences of the resulting household air pollution (HAP). The goal of this proposal is to participate in the Global Network for Women's and Children's Health Research and to study whether cook stoves and fuel that reduce HAP can improve pregnancy outcomes and child health.